To receive a confirmed quote, please complete the form below.
If you prefer to talk to a broker first, call 1300-881-779 during business hours.
If you have spoken to a broker in our office, note their name here so that this quote can be processed by them as they will know something about you already.
Brokers Name:
Insured Name
Trading Name
ABN No.(if known)
Full Address
Email Address
Website Address
Phone No. *
Start date of business:
What is your occupation (eg.management consultant):
Please provide us with a full description of Your business activities. This should include a description of Your business's main area of expertise and the types of services you provide.
Are you involved in corporate consulting to large Public Companies? Yes No
Do you hold the necessary qualifications to perform these tasks? Yes No
Please nominate the amount of covers you require:
Professional Indemnity
$1,000,000
$2,000,000
$5,000,000
$10,000,000
Public Liability
Not required
$20,000,000
Do you provide advice or services in any of the following areas:
No. of people in the business
Gross Revenue - last year If Nil, put in "0"
Estimated for next year If Nil, put in "0"
Please state the percentage of Your activities (based on income) applicable to each State
Do you employ contractors, sub-contractors? Yes No
Does your occupation involve manual risk exposure? ie. does your occupation involve:
Have any claims been made against You or Your business or any prior business or has any fact or circumstance been notified to insurers that has the potential to give rise to such a claim? Yes No
Is anyone in the business aware of any CIRCUMSTANCES which may give rise to a claim against this business? Yes No
Have you (or any person receiving cover under this policy) ever:
By submitting this Declaration, the Applicant acknowledges:
Name of person making this declaration:
Duty of Disclosure - What you must tell us Under the Insurance Contracts Act 1984 (the Act), you have a Duty of Disclosure. You are required before you enter into, renew, vary, extend or reinstate your Policy, to tell us everything you know and that a reasonable person in the circumstances could be expected to know, is a matter that is relevant to our decision whether to insure you, and anyone else to be insured under the Policy, and if so, on what terms. You do not have to tell us about any matter that diminishes the risk that is of common knowledge that we know or should know in the ordinary course of our business as an insurer, or which we indicate we do not want to know. If you do not tell us
If you do not comply with your Duty of Disclosure we may reduce or refuse to pay a claim or cancel your Policy. If your non-disclosure is fraudulent we may treat this Policy as never having worked.
Claims Made Policy This declaration is for a claims made and notified Policy of insurance. This means that the Policy covers you for claims made against you and notified to the insurer during the period of cover. This Policy does not provide cover in relation to: